Needle tract seeding of pancreatic cancer in the gastric wall after transgastric EUS FNA/B: a case series

Aims Endoscopic ultrasound FNA/B has a central role in early diagnosis of pancreatic cancer with high diagnostic accuracy and a good safety profile. Concerns have arisen regarding needle tract seeding and implantation of tumor cells into the gastrointestinal wall after FNA. Cases of gastric wall seeding have recently been reported in patient with body-tail pancreatic cancer who underwent transgastric FNA/B. The aim of our study was to evaluate the incidence of gastric wall seeding after transgastric EUS FNA/B.

Methods We retrospectively selected patients who underwent EUS FNA/B of pancreatic body-tail cancer with a transgastric approach in our national cancer institute. Only patients with at least 6 months of follow-up including imaging (total body CT or PET) were included. Imaging were also reviewed by experienced radiologists. In case of suspected gastric wall seeding, EGDS and EUS FNA/B was performed for diagnostic confirmation.

Results 70 patients were included in the study, 40 men and 30 women. The median age was 64.8. The median follow-up was 11.5 months. In 60/70 patients a 22 G needle was used. The number of passes was 3 in 63/70 patients. In only one patient gastric wall seeding was demonstrated after 33 months after EUS FNA/B with 22 G needle and 3 passes.

Conclusions Our data, according to previous reports, demonstrated 1.4% gastric wall seeding after EUS FNA/B with transgastric approach. Seeding was detected first by abdominal CT and then histologically confirmed by EUS FNA (hypoechoic 23 mm mass in submucosal layer of gastric wall). At retrospective imaging review, seeding was identified 33 months after FNA/B and 26 months after surgical pancreatic resection and neoadjuvant chemotherapy. Unlike pancreatic head cancer, in patients with body-tail cancer surgical resection usually does not include the gastrointestinal tract wall through which FNA was performed. Although rare, gastric wall seeding should be considered in this category of patients to provide the most appropriate post-operative follow-up.

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Artikel online veröffentlicht:
27. März 2025